Provider Demographics
NPI:1639928690
Name:SSM HEALTH CARE ST. LOUIS
Entity type:Organization
Organization Name:SSM HEALTH CARE ST. LOUIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:FOTHERINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-994-7930
Mailing Address - Street 1:301 CALEDONIA PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-6690
Mailing Address - Country:US
Mailing Address - Phone:636-202-6810
Mailing Address - Fax:636-202-6811
Practice Address - Street 1:301 CALEDONIA PKWY STE 110
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-6690
Practice Address - Country:US
Practice Address - Phone:636-202-6810
Practice Address - Fax:636-202-6811
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SSM HEALTH CARE ST. LOUIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-14
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy